THURSDAY, March 8, 2018 (HealthDay News) -- Your wallet takes a hit when you donate a kidney to save someone's life.

That could be the reason for a steady decline in U.S. kidney donations by men and by people in low-income households, a new study suggests.

The living kidney donation rate among men dropped by 25 percent between 2005 and 2015, but remained stable among women, the researchers found.

Kidney donation rates also declined for poor and lower-income families over that period, according to the report.

Money appears to be at the root of these trends, said Dr. Jagbir Gill, an assistant professor of nephrology at the University of British Columbia in Vancouver, Canada.

"We found that in both men and women, donation rates dropped the most in the lower-income groups, and the effect was much more pronounced in men," Gill said.

Medical costs are covered for people who choose to donate a kidney, but many incidental costs are not repaid, he said. These include travel expenses and lost wages from missed work time.

"We believe because there are these financial barriers to donation, people in higher-income groups are able to sustain that more," Gill said. "People who are in lower-income groups are taking a big financial hit and they might not be able to support that hit when they donate."

Living kidney donations declined from 6,647 in 2004 to 5,538 in 2014, said Dr. Krista Lentine, a professor of medicine at St. Louis University and chairwoman of the Living Donor Committee for the United Network for Organ Sharing.

The supply of donated kidneys is not keeping up with demand. About 101,000 people await kidney transplants in the United States, but in 2014 only 17,100 kidneys came from living or dead donors, according to the National Kidney Foundation.

To figure out why fewer people are donating kidneys while they are alive, Gill's team analyzed transplant data and U.S. Census data.

The investigators compared donation rates among income categories, and found that living donation declined among both men and women who were in the lower half of U.S. earners.

But while donation remained stable or even increased among women in the top half of the nation's earners, it either declined or remained stable among men.

"Men typically or more commonly are the primary earner in the household. They have more dependents on their health insurance plans. They also are generally paid more than women," Gill said.

"What may be happening is that the financial consequences of taking time off work or concerns over job security may be more marked in men than women, and that may be why we're seeing this drop in men," he added.

Lentine said these results suggest that financial concerns may play a stronger role in the decision to donate a kidney than the potential risks of donation.

"There's a growing recognition of the risks of donation," she said, pointing to research that found a small but significant increase in kidney failure risk among donors. "I personally don't think that's a major contributor to the decline, but it's important to recognize and to counter that."

It's against the law to pay organ donors in the United States, and rightly so, Lentine noted.

"The countries that have done that have raised a lot of concerns for capitalizing on the vulnerable," she explained.

But steps can be taken to make sure that kidney donation doesn't also pick a person's pocket, Lentine said.

The American Transplant Foundation pointed to the proposed Colorado Living Organ Donor Support Act as a potential way to protect donors from taking a financial hit.

It would grant organ donors at least 10 days of paid leave, and provide employers a 35 percent tax credit on the employee's regular salary for the leave period.

"This is a specific example of what can be done to make giving the Gift of Life easier for all living donors, regardless of their gender," the foundation said in a written statement.

Another piece of legislation is the Living Donor Protection Act, a proposed federal law that would bar insurance discrimination against donors and protect their right to coverage under the Family and Medical Leave Act, Lentine said.

The new study was published online March 8 in the Journal of the American Society of Nephrology.

Finding Organ Donors Concealed in Plain Sight

David Bornstein

Second of two articles.

Last June, after it became clear that their 3-month-old son, Nathan, needed a liver transplant, Rob and Christina Whitehead of Mokena, Ill., created a Facebook page to tell his story. Word spread quickly. “More than a hundred people called our donor hotline,” recalled Talia B. Baker, director of the Living Donor Liver Transplant program at Northwestern University Feinberg School of Medicine.

A Cost-Benefit Analysis of Government Compensation of Kidney Donors

Abstract

From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments—$1.45 million per kidney recipient—but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy—about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.

Study: $50,000 Would Make Most Americans More Likely to Donate a Kidney

Yet compensating donors remains illegal

June 24, 2016

The majority of U.S voters surveyed by telephone stated they’d be more likely to donate a kidney if they received $50,000 in compensation, according a recent study.1 However, paying donors remains illegal under the National Organ Transplant Act of 1984. The study’s key findings include the following:

68% of participants would donate a kidney to anyone, 23% would donate only to certain people, and 9% would not donate.

59% said being paid $50,000 would make them more likely to donate a kidney, 32% said compensation did not sway them, and 9% were negatively influenced by payment.

The researchers conclude that, “because thousands of lives might be saved should compensation increase the number of transplantable kidneys, laws and regulations prohibiting donor compensation should be modified to allow pilot studies of financial incentives for living kidney donors.”

Thomas G. Peters, MD, FACS, FASN, the study’s lead author and professor emeritus in the department of surgery at University of Florida’s College of Medicine in Jacksonville, views the findings as a call to action.

“The striking number is the 59% that would be moved further toward donation if offered compensation,” he says. “That’s six out of ten people.”

From 2004 to 2013, the authors note, 63,742 patients died or became too sick for a transplant while waiting for a kidney. “The ethical implication, in my view, is that we have a potential source of lifesaving organs that is not being accessed,” says Peters. “Because of that, people who are fully evaluated and deemed appropriate for treatment with a kidney transplant are dying while they are waiting.”

While some programs reimburse donors for lost wages, travel expenses, and follow-up care, many donors do not qualify. “The ethical question, in my view, is that we have identifiable, salvageable individuals who are facing needless death because we don’t have the means to save them,” says Peters. “These people have a name, they are cared for by a particular medical center in America, and are on a waiting list.”

Peters uses the analogy of an orthopedic surgeon caring for a patient needing a knee replacement, who could put in an artificial knee, enabling the patient to walk that same day. “It’s the same with kidneys — only we can’t replace the kidney we’d use today with a kidney we might get tomorrow from a living donor,” he says.

The following are ethical arguments used against paying kidney donors:

• Such payment would commodify body parts.

“The fact is, though, that in America it’s legal to pay surrogate mothers, and ova and sperm donors,” Peters says. “And certainly everyone in the transplant endeavor is paid.” That includes the hospital, the transplant surgeon, the transplant coordinator, nurses on the transplant floor, and immunology experts. “Everybody is paid but the donor,” says Peters.

• A black market for organs could develop.

“But our concept is that this all would be highly regulated,” says Peters.

• Payment could coerce persons to perform an act that they ordinarily would not perform: donating a kidney.

“Well, that’s the whole idea. That’s what we want,” says Peters. “Even though our paper indicates that the vast majority of people are willing to give a kidney to anyone or someone, over 90%, it really doesn’t happen.”

What people say they’ll do is not necessarily what they do in reality, he says.

“In our cohort of respondents, most people were positive about donating,” says Peters. “But if you offer the money, that moves the needle. And it might move it in real time.”

Peters says it’s important to consider the history behind the National Organ Transplant Act of 1984, which made it illegal for individuals to sell organs. “Those persons who said we should not pay donors were mostly the transplant surgeons, who opined at the time that altruism was the motivation that ought to drive organ donation,” says Peters.

The idea was reinforced when a businessman attempted to start a brokerage service paying individuals for kidneys, which was completely unregulated. “We were all appalled by that,” says Peters. Peters and others met with former Vice President Al Gore, at the time a Tennessee Congressman, who wrote into the bill the clause about barring compensation.

“However, Gore said at the time, that if the circumstances of organ donation without compensation does not meet the need, then we should reconsider whether or not some form of compensation should be tried,” says Peters. “That is something that is very seldom spoken about.”

The origins of the law, says Peters, “were largely the brainchild of those of us who were practicing at the time.” Though the numbers of individuals on a waiting list who died needing a kidney were small at the time, Peters still viewed the deaths as needless. “There were not a lot of people who agreed with me at the time. I was outspoken about this and did not have a lot of collegial support,” he says.

Over the next decade or two, the numbers of people on the transplant recipient list grew. “We were able to save more and more lives, but the lives we were saving were of a miniscule number compared to the need,” says Peters.

The need is now so great, and the resources so scant, says Peters, that other approaches are needed to increase the recovery of transplantable organs. “A lot of smart people have tried to do it,” says Peters. “All of the ideas for the last 30 years that have been tried have failed.”

Pennsylvania Congressman Matt Cartwright recently introduced legislation that would allow for certain non-cash incentives, such as contributions to a retirement fund, to compensate donors.

“There is no question that what we are doing currently is failing,” says Peters. “Even the opponents say we have to improve organ donation. It’s failing, and it is costing lives needlessly.”

The tricky issue has publicly resurfaced through a widely shared TEDMed talk by a woman who wanted to donate a kidney but couldn’t afford to, and through several opinion pieces published by doctors in medical journals.

There has been a renewed interest in compensation for living kidney donors in the U.S. While paying for organs is still prohibited in the country, a new survey showed that most Americans are fine with the idea of donating their kidney. Even more would do so for the right price.

Most kidneys transplanted in the United States come from deceased donors, and there are never enough for all the people who need one. The waiting list today has more than 100,000 patients, and, every year, thousands die while they wait. The shortage is so severe that many have begun to look at "living" donors as a possible solution. While U.S. transplant rules allow for healthy people to donate their extra kidney to someone who is sick, the process can be time-consuming and expensive, resulting in too few Americans donating.

THURSDAY, March 24, 2016 (HealthDay News) -- If offered $50,000, nearly three out of five Americans would donate a kidney, according to survey results published online March 23 in JAMA Surgery.

"It appears that American society is ready to accept the concept of paying kidney donors," lead researcher Thomas Peters, M.D., an emeritus professor of surgery at the University of Florida College of Medicine in Jacksonville, told HealthDay.

One of the strictest tenets of the U.S. transplant system is that paying for organs is forbidden. The ban, imposed by the National Transplant Act of 1984, was designed to protect the poor from being taken advantage of by the wealthy. Impassioned supporters of the law argued that compensating people for body parts is exploitative and treats donors like subhumans, and the debate was essentially closed for more than three decades - until recently.

Researchers found that paying kidney donors can help boost organ donation rates in the United States. Their findings suggest the need for modifying current regulations and laws prohibiting such incentives that could potentially help save thousands of lives.